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How does Medicaid work with Medicare to cover my health care costs?
Section VIII.c. Medicaid and Medicare
Last Update: January 05, 2009
All states offer a variety of Medicaid programs and several can help people with Medicare. If you qualify for a Medicaid program (no matter which one), Medicaid can help pay for costs and services that Medicare does not cover. Medicare is the primary payer and Medicaid pays second.
For services that both Medicare and Medicaid can cover (such as doctors' visits, hospital care, home care and skilled nursing facility care), Medicare will pay first and Medicaid will pay second, by covering your remaining costs, such as the Medicare coinsurances and copayments.
In many cases if you have Medicaid, you will automatically be enrolled in a Medicare Savings Program (the Qualified Medicare Beneficiary program or "QMB"). Also run through Medicaid, QMB will offer additional assistance by paying your Medicare Part B premium, deductibles, coinsurances and copayments. You will need to meet the guidelines for QMB eligibility in your state.
If you have Medicare, Medicaid and QMB, you should be able to go to any doctor or provider who takes Medicare, Medicaid or is in your Medicare private health plan's network without having to pay the Medicare coinsurances or deductibles. You may still have to pay the Medicaid copayment for the service, depending on the rules in your state. However, if you go to see a provider who takes Medicare and Medicaid, the provider is most likely to bill correctly. If your provider bills you incorrectly, you should call your local State Health Insurance Assistance Program (SHIP)
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Dad Died, Mom Has Dementia. Should I Tell Her?
by Carol Bradley Bursack
Unequivocally, yes. That's the short answer. However, the question and answer, which those who have not experienced this dilemma would say is a "no-brainer," is much more complex to those who stare this harsh reality in the face.
Here's my story:
My struggle began as we finally were able to get my suffering father into hospice care. I'd fought doctors for quite awhile, with the help of the nurses in the nursing home who knew him well, to get him better pain relief. The attitude of the doctor, who viewed his chart, was that he slept a lot, so he wasn't in that much pain.
His body language told a different story. He'd half raise his head from the bed and slam in closed fist into his hand over and over, struggling to get out words that made no sense. He couldn't articulate his pain, but he was trying to beat it to death. Dad was a gentle man, and this behavior was desperate. The nurses knew it, and so did we, his family. After much arguing, the head nurse broke through the barrier with the doctor in charge, and we signed the papers for hospice care.
The dilemma: Mom and Dad, by this time, shared a room in the nursing home. For many years, they'd had private rooms in on the same floor, but the end was near for both, and we felt they needed to be together for the transition (also, their money was nearly gone from the nursing home expense).
I didn't want Mom to be told Dad was going on hospice care, as I knew she'd immediately think "death." After all, that is what hospice care does - help people live comfortably while they die. But, I knew this news would be horrible for mom, who was suffering much physical pain, as well as dementia, to bear. So, I wanted to keep the facts quiet.
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I'm Not Good at Managing My Money.
Steve Rhode
"Dear Steve, I make over $100,000.00 a year and I don't know where my money is going. I have all my credit cards maxed out and I am living from pay check to pay check. Please help! My credit cards have high interest rates and I have asked them to lower but their answer is no. I pay over the limit and have been late. But not intentionaly. Eletha" Dear Eletha, Not everybody is good with managing money. I have always found that those that are most creative, like artists and sales people are horrible at managing the finer points of deal with their finances. I'm sure it is a right brain, left brain thing. Finding someone to manage your money for you seems like a good thing for you to do. We hire people to mow our lawns, clean our homes, so why not hire someone to professionally manage our finances. The cost of hiring a Daily Money Manager is going to be less in the long run than the cost of perpetual financial mistakes or high interest rates. Contact the American Association of Daily Money Managers to find someone near you that can help. www.aadmm.comBig hug. Steve | |
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Understanding Power of Attorney
There's more to estate planning than deciding who will get your money after you die. Estate planning also means deciding who will manage your business and legal affairs if you ever become incapacitated.
What You Should Know
A Power of Attorney is a legal document in which you give another person legal authority to act for you. The Power of Attorney can cover simple tasks like writing or endorsing checks. It can also involve more complex matters like selling real estate.
The Power of Attorney can be very specific or very general. You can authorize just one task, like selling a car. Or, you can give your agent the power to do everything you can now do for yourself. Your attorney will be able to help you understand how you can tailor the Power of Attorney to fit your wishes and needs.
Choosing Your Agent You can give Power of Attorney to anyone you choose. Your agent does not have to be an attorney. Choose someone you can trust. It might be your daughter, or your brother, sister, or spouse. Be sure to ask an attorney to draw up the documents.
Don't be concerned that your agent will "take over" or that you won't be able to make your own decisions. Think of a Power of Attorney as giving someone a second set of keys. You will still have your own keys, but your agent will have keys, too. You can take the agent's keys back any time you want, by revoking the Power of Attorney.
Types of Power of Attorney
The are four types of Power of Attorney. The type you choose will depend on how much authority you want your agent to have; when you want your agent to start acting on your behalf; and when you want your agent's authority to come to an end.
Limited Power of Attorney. Through a limited Power of Attorney you authorize another person to do specific things for you for a limited period of time, or in certain circumstances. The limited Power of Attorney ends if you become incapacitated or die. It also could end at a time that you specify in the document.
General Power of Attorney. A general Power of Attorney gives another person the authority to do whatever you can do. Think very carefully before signing this type of document. It should be used sparingly. This document ends when you become incapacitated or die.
Durable Power of Attorney. A durable Power of Attorney authorizes your agent to continue to act for you after you become incapacitated. This document ends at your death. It can take effect as soon as you sign it.
Springing Power of Attorney. A springing Power of Attorney can be written so it goes into effect if you become incapacitated. Be very careful to define clearly exactly how others will determine that the "springing event" has occurred. Read Article |
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BPS will provide a free initial consultation.
We will meet with your client free of charge to assess thier situation.
This process helps us evaulate what the persons needs are so we can best determine what services are needed or available to them.
During this meeting we will provide information to your client and their family regarding our services, fees and how we would work with them.
We also provide consultations by phone for out of state clients and families.
If you have questions or would like a consulation, please call our office.
Colorado: 303-282-8882
Indiana: 812-944-4200 |
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Supreme Court sets standard for care of relatives' assets
By MIKE DENNISON
Gazette State Bureau
HELENA - In less than four years, a Missoula woman converted some $400,000 of her elderly, bedridden mother's assets primarily for her own use, including bank accounts, income and property, court records say.
The Montana Supreme Court this spring upheld a ruling that said she improperly took the money - and established a new, stronger standard for those entrusted with their relatives' finances, says an attorney involved with the case.
"It's really the first statement of a fiduciary duty between family members," said Richard Reep, a Missoula lawyer who represented the mother's other three children, who sued to uncover what happened to their late mother's assets. "This will hold (relatives) to a stricter standard ... and I think it should."
Others familiar with elder-abuse cases also hailed the high court's April 21 decision as a welcome strike against financial abuse of the elderly.
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Are Your Siblings More Interested In Getting An Inheritance Than Parents' Quality of Care?
by Carol Bradley Bursack
"We don't want strangers taking care of Mom!"
"We promised Mom she would never go to a nursing home!"
"If you really love Mom, you should be able to keep it up for awhile longer, anyway." Ah, siblings. Some are a joy. Some are helping you, the primary caregiver, as you struggle to find the right balance of care for your aging parents. But some, maybe more than we'd like to admit, have a less than admirable motive for their comments. Some don't want Mom to have outside care, because outside care is expensive. And outside care will quickly eat up their parents' hard-earned money - the money the family was to inherit.
While I didn't have to battle siblings over money, I know first hand what happens to an aging parent's estate when outside care and nursing home care is involved. We, as a family, wanted the best care possible for our parents. And for much of the time, I was the best resource.
However, the time came when a nursing home was the only option. I still was the primary caregiver, going to see them every day, making sure their wants and needs were personally taken care of. I was their advocate and watchdog, their hand-holder and errand runner. But their home was the nursing home, and everything they had hoped to leave the family, financially, ended up paying for their care. That's fine. It's not what they wanted, but their care came first, and their money paid for it.
Would my siblings and I have loved to have a little inheritance? Of course. My parents desperately wanted to leave us something. But that was not to be. That's okay. Mom had her private room. She had good care. Dad's care was private pay, as well. My siblings understood that this is how it needed to be. My continuing to care for them at home was no longer an option.
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| * Please note: the views or opinions expressed in the included news articles are not necessarily those held by BPS, Inc. We do not personally endorse or guarantee any service providers or agencies that are featured in our publication. | |
Thank you for your continued support and referrals. We appreciate what each and every one of you do to contribute to the community in which we live.
Sincerely,
Courtney L. Smith, RG, PDMM
Benefit Payee Services, Inc.
Colorado: Indiana:
PO Box 101775 PO Box 9
Denver, CO 80250 New Albany, IN 47151
Phone: 303-282-8882 Phone: 812-944-4200
Fax: 866-339-1918 Fax: 866-339-1918
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Courtney's Corner...
Courtney L. Smith, NCG, PDMM
6 Steps to Determining the Best Service Solution for Your Client
When a professional advisor or family member calls inquiring about fiduciary or money management services there are 6 fundamental areas we review to determine which service would be most appropriate.
Different types of services that may be addressed are:
¨ Daily Money Management
¨ Durable Power of Attorney
¨ Conservatorship
¨ Trust Administration
¨ Representative Payee
These areas are not in any specific order and are most often used in combination with each other when trying to assess what services will work best.
1. Does the client have capacity to make decisions for themselves?
If your client has limited capacity or severe cognitive deficits then the establishment of a trust, daily money management or power of attorney may not be options for them.
Although in some situations an adult child can hire a daily money manager to work with their parent or the current agent or trustee may be able to delegate or appoint a successor agent of their choice.
As a general rule: Capacity will play a part in determining service options.
2. What types of assets are involved and what is their value?
Do they have real or personal property? Bank accounts? Investments? Vehicles? Are they on government programs such as Medicaid? Is the person's estate worth $10,000 or $1,000,000?
Sometimes the type and value of someone's estate can warrant the decision of a particular service plan such as a Conservatorship versus Representative Payee.
3. What type of monthly income do they receive?
This becomes important if the only form of income is Social Security or VA income. If this is the case and we have determined that they have little capacity and limited assets then they probably would need a Representative Payee or Legal Custodian instead of a court appointed Conservator.
If they have multiple forms of income in addition to Social Security then you will need to add another service level on top of Representative Payee in order for the agent to have the authority to manage the other income.
4. What are the family dynamics?
Most people who need a third party professional usually have some type of family dynamic involved such as:
- Lack of family to help
- Family who live out of state
- Family members who do not get along
- Family members who do not have the skill set or expertise required
- Children who may have disabilities or drug and alcohol addictions
- Family who exploit or take advantage of them
- Family who don't have the time
If we need to protect the person's assets from their family then daily money management is usually not the best fit for them.
Depending on whether or not your client has capacity, I would suggest a more supervised or controlled arrangement such as a Trust, POA, Rep Payee or Conservatorship.
5. What control or participation level does the client want to maintain.
Depending on a person's level of capacity, they may want to have as much or as little involvement in the overall day to day management of their affairs. This information is important to know as it may change the level or type of service provided.
We always look for the service level that will be least restrictive and we strive to maintain a our client's independence and dignity.
6. What estate planning, if any, has already been done?
Does the client already have a power of attorney, a will or trust document in place? Sometimes a family member who is currently acting as an Agent under a trust or power of attorney no longer wants to assume that role and it is often necessary to determine what type of flexibility those documents may have.
If they have already completed their estate plan, we would want to know who has already been appointed to act as their Agent and are the documents, such as a Trust irrevocable?
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Determining what type of service a person may need is not a one size fits all approach. Every individuals personal circumstance is different and it's important that all possible solutions be evaluated prior to making a decision.
If you have a client that is in need of money management or fiduciary services but you aren't quite sure what would be the best solution for them, feel free to contact me and I will be happy to discuss the options with you.
- Courtney |
Daily Money Management
Bill Paying & Bookkeeping
Conservatorship
Financial Power of Attorney
Trust Administration
Personal Representative/Executor of Will
Representative Payee
Organization of Tax Information
Financial Oversight and Auditing for Pro Se Families |
Budgeting
Financial Coaching
More Information on Our Services
(Not all services may be provided in every State) |
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Judge leans against Falk conservatorship
Mar 23, 2009
LOS ANGELES (AP) - A judge has refused to establish a conservatorship for Peter Falk, but has scheduled testimony to decide whether court intervention may be necessary.
Los Angeles Superior Court Judge Aviva Bobb on Monday seemed inclined to throw out a petition by the actor's adopted daughter, but postponed a ruling so that an evidentiary hearing can be held in May.
Catherine Falk petitioned for a conservatorship over her father last year and has argued that it is necessary to ensure visitations. In court documents, she has stated that the actor suffers from Alzheimer's disease and advanced dementia.
The move is opposed by Falk's wife of 32 years, who was designated before Falk's illness as caregiver and the keeper of his estate. |
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Only in Boulder: A home for pet 'guardians'
The inspiration for a campaign came to Rita Anderson just after a cold winter day in 1999, as she watched a Dalmatian she called "Mikey" shivering in a backyard that bordered on Martin Park.
Legally, the dog's owners weren't being cruel. Mikey had a doghouse where he could escape the cold and the heat, which is what animal control officers told Anderson when she called them asking for help -- as she did on several occasions.
Then a friend told her about a budding movement among animal-rights supporters to refer to pets' owners as "guardians." And that's when she decided to try and convince the Boulder City Council to change the city's ordinances, striking "owner" in favor of "guardian."
"What if these people, instead of thinking, 'We own Mikey' -- what if they thought of themselves as guardians, and what if they thought of themselves as having responsibilities toward him as a sentient being with his own needs and his own rights?" she said.
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Who and what is a PGCM?
Q: What is a Professional Geriatric Care Manager?
A: A professional geriatric care manager (PGCM) is an expert, such as a social worker, counselor, gerontologist or nurse, who specializes in assisting older people and their families to attain the highest quality of life given their circumstances.
Q: Who uses a PGCM?
A: PGCMs provide services that assist individuals and families. Businesses and professionals in the legal, health, and financial arenas, utilize PGCMs to ensure that their clients understand their options, have their needs met, and they receive quality care.
Q: How can PGCMs assist family caregivers?
A: PGCMs assist families and caregivers in numerous ways. They conduct elder care-planning assessments to identify problems and to provide solutions; screen, arrange, and monitor in-home care or other services; provide short- or long-term assistance for caregivers living near or far away; review financial, legal, or medical issues and offer referrals to geriatric specialists; provide crisis intervention; act as a liaison to families involved in long distance caregiving, overseeing care, and quickly alerting families to problems; assist with moving an elder person to or from a retirement complex, assisted care home, or nursing home; provide consumer education and advocacy; offer counseling and support. Some PGCMs also provide family or individual therapy, finance management, conservatorship or guardianship assistance, and/or caregiving services. www.caremanager.org | |
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